| Impact Health Direct Primary Care, Pllc | |
|
1905 W Ennis Ave Ste 504b Ennis TX 75119-3630 | |
| (972) 846-4800 | |
| (410) 237-6747 |
| Full Name | Impact Health Direct Primary Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1905 W Ennis Ave Ste 504b, Ennis, Texas |
| Authorized Official Name and Position | Kara Sjogren (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9728464800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Health Direct Primary Care, Pllc 1905 W Ennis Ave Ste 504b Ennis TX 75119-3630 Ph: (972) 846-4800 | Impact Health Direct Primary Care, Pllc 1905 W Ennis Ave Ste 504b Ennis TX 75119-3630 Ph: (972) 846-4800 |
| NPI Number | 1760004188 |
|---|---|
| Provider Enumeration Date | 05/07/2020 |
| Last Update Date | 05/07/2020 |
| Medicare PECOS PAC ID | 8527499839 |
|---|---|
| Medicare Enrollment ID | O20200520000994 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760004188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kara Elizabeth Sjogren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992142533 PECOS PAC ID: 3072809961 Enrollment ID: I20200520001161 |
| Provider Name | Michael Charles Booth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184073629 PECOS PAC ID: 6103199005 Enrollment ID: I20230509003113 |
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